Driven

There was a neat article in the Boston Sunday Globe about American Hypomania. Yeah, it sounds like the latest craze, but a new book suggests it may have been going on for centuries:

In his new book "The Hypomanic Edge: The Link Between (A Little) Craziness And (A Lot of) Success In America" (Simon & Schuster), John Gartner contends not only that most of today's successful entrepreneurs and businesspeople are hypomanic, but that many of our history's leading figures, such as Alexander Hamilton, Andrew Carnegie, and Henry Ford, had the condition as well. The United States has more hypomanics than other countries, Gartner claims, and these people are largely responsible for the nation's power and prosperity.

I remember learning about hypomania in the context of bipolar disease (manic-depression) in med school. Many of my classmates suspected they were hypomanic, or would need to be in order to graduate. Indeed, when you read the DSM-IV criteria for a hypomanic episode, it doesn't sound half bad:

A distinct period of persistently elevated, expansive or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood...

...inflated self-esteem or grandiosity, decreased need for sleep (e.g., feels rested after only 3 hours of sleep)... flight of ideas or subjective experience that thoughts are racing...increase in goal-directed activity (at work, at school, or sexually)...

...The mood disturbance not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

Sounds great, right? Well, I'm leaving out the undesirable features -- distractability, irresponsible spending sprees, pressured speech -- and condensing the APA legalese. It's worth noting that, according to DSM, hypomania differs from full-blown mania only in that it can last just four days (mania requires a week) and that it doesn't markedly impair functioning. That's it. Follow the link above to see the rest, and learn how hypomanic episodes are a component of bipolar disorders.

It's sufficient to say that preclinical med students aren't the only people a little enamored with this disease. Even psychiatrists with a lot more experience treating bipolars think there's something attractive about hypomania. It's a small step from that, to assigning hypomania a role in making this nation great. But Dr. Kay Jamison, who herself is bipolar and has some fond memories of it, sounds aword of caution:

"Certainly there have been studies, long before his book, suggesting that there is a disproportionate rate of bipolar illness in immigrant populations, which is not surprising, really, when you think about the energy and the optimism and impulsiveness that drives people to immigrate," she said in a recent telephone interview. "Now, does that mean that most Americans are hypomanic? No, that means - at least from my point of view - that a very real minority may be hypomanic, though perhaps a very important minority."

Gertner apparently acknowledged that his book has no reasonable proof, just a provocative correlation. He elaborates:

"What I'm doing is putting certain things together, drawing an inference," he says. "I'm saying: 'Look, isn't it interesting that the countries that have been havens for immigrants also have the highest rates of bipolar disorder? And isn't it interesting that those are the countries that have the highest rates of new company creation?' Yes, it could be coincidental - but in science, we say that the simplest explanation is usually the right one."

It seems far simpler, to me, to say the following: the American system, with its lack of tradition, its relatively trustworthy institutions, and its extensive natural resources, encouraged the citizenry to take risks. Many did, leading to an unparalleled prosperity. Their wealthy decendants are now able to obtain psychiatric diagnoses that their counterparts in the Old Country cannot, and thus Americans lead the world in a number of disorders, including bipolar.

Jamison thinks that immigrants tended to have bipolar traits, compared to those left behind. But really, why not obsessive-compulsive traits? After all, one would need to be meticulous about planning to leave home, and those traits would serve one well in American business. And I wouldn't be surprised if Americans lead the world in OCD diagnoses, too. But no one's yet ascribed our economic state to that disease -- perhaps it's not as glamorous.

Anyway, any attempt to prove this hypomania hypothesis will be tough. It's easy enough to measure spending habits, and bankruptcies, but hard to attribute that to hypomania when there are so many external forces involved. Same with hours slept (Americans do work more and sleep less than others), and frequency of sex (Durex says we're #1). But again, is U.S. culture reinforcing these behaviors, or hypomanic behavior creating the culture?

They'd have an easier time explaining our high oil consumption with the obsessive-compulsive fear of public transportation. Much easier to study. I really think someone should look into this. I would, but I have too many other ideas to follow up on right now...